Demographic and clinico-pathological profile of carcinoma stomach in a tertiary referral centre of Eastern India

Objectives: This prospective study was done to assess the incidence, clinical presentations, histopathological subtypes of gastric adenocarcinoma in a referral institute of Eastern India. Methods: The patients admitted with diagnosis of gastric carcinoma in a tertiary referral hospital in Eastern India between January2006 to December2010 were included in this study. Data were compiled and analyzed with regards to their age, sex, socioeconomic status, their clinical presentations, site of lesion & histopathological subtypes. Results: 150 patients were included in this study of which 50 patients were of ≤50 years age. The median age group was 57 years. The male: female ratio was 2.3:1. Most of the patients were from lower socioeconomic strata (55.33%). Anemia (41.33%) and weight loss (38%) were the predominant presenting features irrespective of age, whereas gastric outlet obstruction due to antral growths was the commonest presentation in patients of ≤50 years age group. The most common histopathological type was adenocarcinoma; patients of≤50 years of age group presented with well differentiated and moderately differentiated adenocarcinoma while those in >50 years age group with poorly differentiated growth. Most (82.66%) of the patients presented with advanced growth(T3/T4). Conclusion: 1) The incidence of gastric carcinoma in patients younger than 50 years was more common than Western world. 2) Patients are presenting more with lesion in distal stomach than Western world. 3) Gastric outlet obstruction and metastatic disease are commoner than abdominal lump and upper GI bleeding. The latter being the commoner presentations in Western world. 4) Regarding the histological type, adenocarcinoma are commoner than in Western world and 5) Patients with signet cell subtype are much less than Western world

Review Article-Bile duct injuries: Mechanism and prevention

Operative bile duct injury is one of the serious complications of hepato-biliary surgery. It is feared because of the substantial morbidity, occasional mortality, additional expenditure and frequent litigation that accompany it. With the introduction of laparoscopic cholecystectomy (LC) there was an increase in the incidence of such injuries and their pattern also changed to more complicated varieties. The popularity of LC and various percutaneous endoscopic procedures for bile duct pathologies have made the younger generation of surgeons less familiar with open cholecystectomy and open operative approaches to bile duct injuries. A review of the literature pertaining to the mechanism of bile duct injuries, during both open and LC, and the techniques of their prevention, was carried out by Medline search; with the aim of helping surgeons in optimising their efforts of preventing these tragic accidents

Primary small gut lymphoma presenting as an incarcerated inguinal hernia in an adult

A 73-year-male presented with features of subacute small gut obstruction of 10 days duration. He also complained of a painless, slowly enlarging swelling in the right groin, which was first noticed 10 years ago. There was a history of weight loss, anorexia, and asthenia but no history of fever, respiratory, or urinary symptoms. He was a smoker and was on medication for hypertension and type 2 diabetes mellitus. The general health of the patient was poor. He appeared pale and dehydrated. No lymphadenopathy was evident on the general survey. The abdomen was distended, tense with hyperactive bowel sounds. Examination of the groin and genitalia revealed right inguinal hernia and an irreducible, firm, solid, nontender, 6 cm × 5 cm scrotal mass separate from the right testis. Digital rectal examination revealed no abnormality. Contrast-enhanced computed tomography of the abdomen showed dilated gut loops, right inguinal hernia, and a gut related endophytic soft-tissue mass in the scrotum. Exploration after resuscitation revealed a firm, endoluminal soft-tissue mass arising from the apex of the herniated loop of the small gut which was obliterating its lumen. The tumor-bearing segment of the gut was resected through a groin incision. We then performed a laparotomy to bring out the ends of the bowel loops as double barrel ileostomy. The hernial defect was then repaired. Postoperative recovery was uneventful. Histopathology of the excised specimen suggested the possibility of Non-Hodgkin's lymphoma of small gut. Immunohistochemistry confirmed it to be low-grade follicular B-cell NHL

Pelvic hydatid cyst: A rare case report

A 25-year-old farmer from rural Bengal presented in the emergency with acute retention of urine and severe radicular pain along the lower back and back of thighs. He had a history suggestive of bladder outflow obstruction for past 1-year, but no history of retention of urine. Radicular pain and marked constipation were of recent onset. There was no history suggestive of urinary tract infection or significant weight loss. There was no past history of surgery, trauma or other major illness. On examination, the bladder was distended and digital rectal examination revealed an anteriorly placed immobile, nontender, extra luminal soft, cystic pelvic mass. Ultrasonography revealed a cystic mass within pelvis with back pressure changes of the kidneys and ureters, while contrast enhanced computed tomography of abdomen revealed a 10.5 cm × 10 cm thick-walled, nonenhancing, unilocular lesion occupying the pouch of Douglas pressing on the bladder neck anteriorly. An ELISA test for echinococcus antigen was negative. Laparotomy revealed an immobile, retroperitoneal, tense, cystic swelling occupying the entire pelvic cavity containing crystal clear fluid suggesting possibility of hydatid cyst. Exploration of the cyst with scrupulous precautions to avoid spillage showed an endocyst. Endocystectomy with partial pericystectomy was done. Patient had an uneventful recovery. This case report depicts an atypical presentation of isolated primary extra-peritoneal pelvic hydatid cyst in a young male hailing from a nonendemic areas

Case Report - Anorectal amelanotic malignant melanoma

A 45-year-old lady presented with history of painless bleeding per rectum for 2 months. Colonoscopy revealed a small growth involving the region of the anorectal junction, biopsy of which was reported to be poorly differentiated carcinoma, with the possibility of amelanotic melanoma. At the time of undergoing abdominoperineal resection the patient did not show any obvious evidence of regional lymph node involvement or distant metastases. Histopathology of the tumour after routine haematoxylin and eosin (H&E) stain and subsequent special staining with anti-melanoma antibodies, HMB 45 and S 100, conclusively proved amelanotic melanoma. She developed multiple secondary deposits in the liver after 3 months of surgery and a recent bone scan revealed multiple metastases in the bones. However, she is still alive at the time of reporting